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1
Introduction
“The confluences of human and animal health, along with wildlife, create
new opportunities for pathogens to emerge and reemerge.”
—Animal Health at the Crossroads: Preventing
Detecting, and Diagnosing Animal Diseases
(National Research Council, 00a)
Zoonotic1 pathogens have caused the majority of the emerging infec-
tious disease events in the past six decades (see Figure 1-1) (Woolhouse
and Gowtage-Sequeria, 2005; Jones et al., 2008). These diseases have the
potential to cause significant morbidity and mortality in humans and ani-
mals, with resulting implications for international trade, travel, economies,
and national security. Global interconnectivity has increased opportuni-
ties for disease emergence and rapid disease transmission, and the various
linkages in the global economy also enable systemic social, political, and
economic consequences (World Economic Forum, 2006). Public awareness
and concern have grown dramatically as the potential for a global pandemic
of influenza was heightened by the emergence of highly pathogenic avian
influenza (HPAI) H5N1 infections and with the arrival of pandemic H1N1
in 2009. There is a need and possible momentum for new country-led
initiatives and international collaborations aimed at managing this global
threat (Murphy, 2008).
CHARGE TO THE COMMITTEE
Statement of Task
The Committee on Achieving Sustainable Global Capacity for Surveil-
lance and Response to Emerging Diseases of Zoonotic Origin was convened
1 A zoonotic disease or infection is transmissible between animals and humans. Zoonoses
may be bacterial, viral, or parasitic, and may involve unconventional agents (IOM, 2003;
WHO, 2008).

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FIGURE 1-1 Emerging infectious disease events detected from 1940 to 2004. The map is derived for disease events caused by all
pathogen types. Circles represent one-degree grid cells, and the area of the circle is proportional to the number of events in the
Figure 1-1 color.eps
cell.
bitmap image
SOURCE: Jones et al. (2008). Reprinted with permission from Macmillan Publishers LTD: Nature.
broadside

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INTRODUCTION
by the Institute of Medicine (IOM) and the National Research Council
(NRC) at the request of the U.S. Agency for International Development
to examine the needs and challenges associated with building sustainable
global disease surveillance and response for zoonotic diseases. This included
a review of the diseases that have emerged in the past several decades and
the drivers associated with their emergence and reemergence; a review of
the current state of existing global disease surveillance systems for zoonotic
disease; and an examination of policy and regulatory options to mitigate or
decrease the threat of zoonotic diseases globally. The committee was also
asked to recommend ways to strengthen and improve coordination of the
human and animal health systems and the mechanisms that govern them
to achieve sustainable and timely disease surveillance worldwide that could
improve the prevention of and response to these disease threats (see Box
1-1 for the Statement of Task).
Limitations on the Scope
Security threats can be caused by the intentional introduction of mi-
crobes for deliberate disease emergence. While the committee recognizes the
dual-purpose nature of zoonotic pathogens and its potential for biosecurity
concerns, this report is instead focused on nondeliberate disease emergence
and events.
In addition, the report predominantly addresses surveillance concerns
rather than focusing on response measures. The committee understood the
importance of acting on surveillance information to prevent and control
emerging zoonotic disease outbreaks. However, given the serious gaps and
challenges that currently preclude early detection and reporting and the
limitations of the committee’s charge, the committee primarily focused
its efforts to address these surveillance gaps and challenges. Significant
additional review, discussion, and consideration would be needed at a
future time to comprehensively assess how best to implement appropriate
evidence-based responses following the detection of an emerging zoonotic
disease in human and animal populations.
The Committee’s Approach to Its Task
Several publications from the IOM and the NRC have examined the
topics of infectious diseases and microbial threats to health and security
(IOM, 1992, 2003), and the challenges and resources needed to strengthen
animal health infrastructure, including the training of veterinarians (NRC,
2004, 2005a,b). This report builds on perspectives outlined in the report
Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing
Animal Diseases (NRC, 2005a).

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0 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
BOX 1-1
Statement of Task
The charge to the committee was to provide consensus advice on the chal-
lenge of achieving sustainable global capacity for disease surveillance and re-
sponse to emerging diseases of zoonotic origin. Specifically, the committee was
to address the following issues:
1. eview the emergence and spread over the past several decades of a diverse
R
range of agents of zoonotic origin.
2. ummarize what is known about the causes underlying this growing phenom-
S
enon, trends in these factors, and the implications for long-term domestic and
international development and security.
3. ssess the evolving nature, extent, and risks of animal and human interac-
A
tions, focusing specifically on recent infectious disease events of international
significance, such as highly pathogenic avian influenza H5Nl.
4. eview the historic human and animal health responses to emergent zoonotic
R
diseases along with lessons learned that may be applicable to future threats.
5. eview the current state of and gaps in global systems for disease surveillance
R
of zoonotic infections in human and animal populations.
6. evelop conclusions on the appropriate balance between emergency re-
D
sponse to threats and establishing sustainable global disease surveillance
capacity for early detection, mitigation, and characterization of known, chang-
ing, and unknown threats.
7. dentify and prioritize for the international context recommendations to
I
strengthen and improve coordination of the human and animal health systems
to achieve a sustainable and integrated institutional capacity for timely disease
surveillance that could improve prevention of and response to zoonotic dis-
eases across both realms.
8. xplore options—including policy and regulatory options, such as international
E
agreements—to mitigate and decrease the threat of emerging zoonotic dis-
eases worldwide, and to improve coordination between governments and other
relevant international organizations.
The Committee on Achieving Sustainable Global Capacity for Surveil-
lance and Response to Emerging Diseases of Zoonotic Origin met over
10 months. A 2-day workshop was held in conjunction with the first com-
mittee meeting in June 2008 in Washington, DC. At the data-gathering
workshop, invited speakers and experts discussed aspects of building
capacity for disease surveillance and response to emerging zoonotic dis-
eases. Speakers and participants included representatives from international
organizations, U.S. government agencies, and researchers and academi-
cians from the Americas, Asia, and Africa. A summary of the workshop
proceedings, Achieving Sustainable Global Capacity for Surveillance and
Response to Emerging Diseases of zoonotic Origin: Workshop Summary,

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INTRODUCTION
was published in December 2008 (IOM and NRC, 2008).2 The committee
collected more information through four additional committee meetings,
two teleconference meetings with invited experts, and multiple conference
calls and electronic communications.
The committee defined several crucial terms for the purpose of this
report, and the definitions are found in Appendix A. The committee consid-
ers public health to include both human and animal health. When human
health officials, clinicians, researchers, or policymakers are referenced in
discussions, the reader should also assume the committee intends to include
their equivalents in the animal health realm, although such interactions are
not yet routine. The committee refers to integrated systems to convey the
importance of connecting and engaging both human and animal sectors in
addressing the problem of emerging zoonotic infectious diseases.
INTERNATIONAL CONTEXT FOR ZOONOTIC
DISEASE SURVEILLANCE AND RESPONSE
An important development in the past decade, driven by the emergence
of HPAI H5N1 and severe acute respiratory syndrome (SARS), has been a
transformation in how governments, international governmental organiza-
tions, and nongovernmental actors think about emerging zoonotic disease
surveillance and response capacities. Human and animal health threats—
and their intersections—have risen in public concern to become subjects
of foreign policy and diplomacy. In this rise to political prominence, the
committee recognized conceptual innovations in the way stakeholders think
about disease surveillance and response capacities, and why they are im-
portant. Through foreign policy and diplomacy, governments attempt to
achieve four objectives:
1. To protect the nation’s security;
2. To advance the nation’s economic well-being and power;
3. To foster development in countries and regions important to the
nation’s security and economic interests; and
4. To protect human dignity through humanitarianism and human
rights (Fidler, 2008).
Although past governance efforts against human and animal health threats
have touched on some of these functions, they have never been systematic
or conducted in ways that really mattered in the “high politics” of national
or international politics. That may explain why the international regimes
for human and animal health developed as devices to reduce the economic
2 Available online through the National Academies Press at www.nap.edu.

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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
burden of outbreaks, even though the World Health Organization eventu-
ally linked human health to human rights by advocating “Health for All”
as a right under the Alma Ata declaration (WHO, 1978). Some key inter-
national governmental organizations relevant to the discussion on global
surveillance and response of zoonotic diseases are described in Box 1-2.
The formal legal obligations that countries have to report emerging
human and animal infectious disease events are only one part of the in-
ternational institutional frameworks that guide the behavior of actors at
the global level; also important are the set of informal norms, rules, and
expectations they share. Because the economic, political, military, or even
moral power relationships between nations are commonly asymmetric, it
is essential to have international governance structures in place to limit
the impact of the hierarchy of power among the participating nations,
particularly if global public goods3—that is shared objectives for the good
of all—are ever to receive support over more narrow national interests.
International “institutions,” including the “persistent and connected sets
of rules (formal or informal), that prescribe behavioral roles, constrain
activity, and shape expectations” (Keohane, 1984; Ostrom, 2005) can play
this role by guiding the interactions of actors towards the achievement of
shared objectives. These institutions are distinct from the actors involved,
which may be states, government agencies, organizations, corporations,
foundations, or even individuals.
While the institutions and the actors can be stable for long periods
of time, some events can so perturb the institutional framework that it
becomes necessary to find and negotiate a new set of rules and roles.
Emerging zoonotic infectious diseases represent such a redefining event
with respect to tourism, travel, and trade of food and animal products
across national borders. Moreover, emerging zoonotic infectious diseases
are not currently predictable, and so the “global institutions” that will gov-
ern the interactions between sovereign states and non-state actors (firms,
nongovernmental organizations [NGOs], individuals) will need to have
flexibility built in and be able to evolve to allow the involved actors to
effectively meet the challenges of governance as they arise. The commit-
tee believes that it is important to distinguish between the institutions, in
the context described, and the actors that must participate in building and
supporting a global surveillance and response system to address emerging
zoonotic infectious diseases. For example, as extensively discussed later in
3 The International Task Force on Global Public Goods defines “global public goods” as
“issues that are broadly conceived as important to the international community, that for the
most part cannot or will not be adequately addressed by individual countries acting alone and
that are defined through a broad international consensus or a legitimate process of decision-
making” (2006, p. 13).

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INTRODUCTION
BOX 1-2
International Institutions and Actors
WHO: The World Health Organization (WHO), created by the United Nations
(UN) in 1948, is the directing and coordinating authority for health within the UN
system. It is responsible for providing leadership on global health matters, shaping
the health research agenda, setting norms and standards, articulating evidence-
based policy options, providing technical support to countries, and monitoring and
assessing health trends. The World Health Assembly is the supreme decisionmak-
ing body for WHO and is attended by delegations from all 193 member states.
The Secretariat of WHO is staffed by some 8,000 health and other experts and
support staff on fixed-term appointments, working at headquarters in Geneva,
Switzerland, in the six regional offices, and in countries. WHO is headed by the
Director-General, who is appointed by the Health Assembly on the nomination
of the Executive Board. WHO collaborates with more than 800 institutions in 90
countries to carry out its programs and activities (www.who.int).
FAO: The Food and Agriculture Organization of the United Nations (FAO), created
in 1945, has the mission of raising levels of nutrition, improving agricultural pro-
ductivity, bettering the lives of rural populations, and contributing to the growth of
the world economy. The organization, headquartered in Rome, Italy, is directed by
the Director-General, elected by the Conference. FAO employs more than 3,600
staff members (1,600 professional and 2,000 general service staff) and maintains
5 regional offices, 9 subregional offices, 5 liaison offices, and 74 fully fledged
country offices—excluding those hosted in regional and subregional offices (www.
fao.org/about/mission-gov/en/).
OIE: The Office International des Epizooties (OIE, also known as the World Orga-
nization for Animal Health) is responsible for improving animal health worldwide.
It was created in 1924 by the ratification of an agreement by member states of
the League of Nations, and it is recognized as a reference organization by the
World Trade Organization. As of June 2009, OIE had a total of 174 member states.
The daily operations are managed by the Director-General, elected by the OIE
International Committee, from the Paris, France, headquarters. The organization
has approximately 40 health experts and support staff. OIE maintains permanent
relations with 36 other international and regional organizations and has regional
and subregional offices on every continent (www.oie.int).
WTO: The World Trade Organization (WTO) is an international organization es-
tablished in 1995 with the primary purpose to open trade for the benefit of all.
It provides a forum for negotiating agreements aimed at reducing obstacles to
international trade and ensuring a level playing field for all, thus contributing to
economic growth and development. It also provides a legal and institutional frame-
work for the implementation and monitoring of 16 different multilateral agreements
(to which all WTO members are parties) and two different plurilateral agreements
(to which only some WTO members are parties), as well as for settling disputes
arising from their interpretation and application. Decisionmaking is generally by
consensus of the entire membership (currently 153 members, of which 117 are
developing countries or separate customs territories). The organization is led by
the Director-General. The Secretariat is in Geneva, Switzerland, with 700 staff
members (www.wto.org).

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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
this report, the revised International Health Regulations 2005 (IHR 2005)
have been ratified by 194 nations and thus represent a legal requirement for
compliance under the IHR protocol. However, the underlying institutions
that will guide behavior as new challenges arise are less clear and less well
understood. Without some debate and agreement on a basic set of rules and
expectations, implementation of IHR 2005 may lag, and a truly effective
global governance arrangement will remain elusive.
ORGANIZATION OF THE REPORT
The report presents the committee’s findings, conclusions, and recom-
mendations on achieving a sustainable global zoonotic disease surveillance
and response system. Chapters 2 and 3 provide background context for
exploring the magnitude of the challenges and threats posed by zoonotic
diseases to human and animal health, macro- and microeconomies, global
trade, and the sociocultural-political impacts and interactions for disease
prevention and mitigation. Chapter 4 analyzes the current global capacity
for zoonotic disease surveillance and response, while Chapter 5 examines
the incentives and protections for improving disease reporting at various
levels. Financing challenges for sustaining global disease surveillance are
discussed in Chapter 6. Chapter 7 describes the governance mechanisms,
processes, and innovations the committee deems critical to strengthening
disease surveillance and response capabilities for human and animal health.
Finally, Chapter 8 provides recommendations for sustaining global surveil-
lance and response to zoonotic diseases and also examines some possible
challenges that will need to be overcome in effectively implementing and
strengthening efforts to protect human and animal health.
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IOM (Institute of Medicine). 1992. Emerging infections: Microbial threats to health in the
United States, edited by J. Lederberg, R. E. Shope, and S. C. Oaks, Jr. Washington, DC:
National Academy Press.
IOM. 2003. Microbial threats to health: Emergence, detection, and response, edited by M. S.
Smolinski, M. A. Hamburg, and J. Lederberg. Washington, DC: The National Academies
Press.
IOM and NRC (Institute of Medicine and National Research Council). 2008. Achieving sus-
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origin: Workshop summary. Washington, DC: The National Academies Press.